Abstract
To review radiographic studies of pediatric patients presenting with periorbital infections and to evaluate sinonasal anatomical factors and clinical course related to this disease process. Retrospective study review of computed tomography (CT) scans in 100 patients less than 18 years old, admitted to a tertiary children's hospital with the diagnosis of an orbital infection. CT scans were reviewed for anatomic variants and Lund-Mackay scores were calculated. An independent chart reviews of the treatment course and need for surgical intervention was performed. Of 100 patients, 67% were male, 60% had left-sided infections, and 30% of patients were treated with surgical drainage. Adenoid hypertrophy (61%), inferior turbinate hypertrophy (80%) and septal deviation (47%) were common, but did not show statistical correlation with the need for surgical intervention. Dehiscence of the lamina papyracea was identified in 21% of patients treated without surgery and in 76% of those requiring surgery (P 0.0048). The average overall Lund-Mackay score was 11.8 and did not correlate with the need for surgical intervention. To our knowledge, this is the first study to evaluate the incidence of sinonasal anatomic abnormalities in children presenting with periorbital infections. This study also demonstrated that lamina papyracea dehiscence is a common finding and is associated with higher rates of surgical intervention. Such findings may have an important role in the diagnosis, surveillance and management of sinus disease in the pediatric population.
Highlights
MethodsRetrospective study review of computed tomography (CT) scans in 100 patients less than 18 years old, admitted to a tertiary children’s hospital with the diagnosis of an orbital infection
The pediatric sinonasal anatomy has not been well investigated with respect to peri-orbital complications of sinusitis
We seek to describe the sinonasal anatomic characteristics and LundMackay (LM) scoring associated with periorbital infections and their relationship to the ultimate need for surgical intervention
Summary
Retrospective study review of computed tomography (CT) scans in 100 patients less than 18 years old, admitted to a tertiary children’s hospital with the diagnosis of an orbital infection. A consecutive review of patients admitted with a diagnosis of periorbital infection from 20032008 was performed. POC is a serious condition with multiple potential complications including orbital abscess formation and intracranial sequelae if untreated. Periorbital cellulitis in the pediatric population is associated with sinusitis [2]. One of the more common and concerning complications of pediatric sinusitis is the development of an orbital subperiosteal abscess (SPA). Potential anatomical pathways for spread of infection into the orbit include: 1) the anastamoses between the valveless venous network that drains the orbit, skin of the periorbital tissues, and the maxillary and ethmoid sinuses, 2) the thin, possibly
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